"Procedure"|"Code Type"|"Revenue Code"|"Procedure Description"|"Payer"|"Plan"|"Inpatient Gross Charges"|"Inpatient Expected Reimbursement"|"Inpatient Max Reimbursement"|"Inpatient Minimal Reimbursement"|"Outpatient Gross Charges"|"Outpatient Expected Reimbursement"|"Outpatient Max Reimbursement"|"Outpatient Minimal Reimbursement" 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.44||||13.44|4.11|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.44||||13.44|8.76|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|13.44||||13.44|9.15|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|13.44||||13.44|11.37|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|CIGNA [1260]|CIGNA [126008]|13.44||||13.44|11.37|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|13.44||||13.44|8.76|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|13.44||||13.44|8.76|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|||13.44||||13.44|4.03|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.44||||13.44|8.76|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|13.44||||13.44|8.76|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|13.44||||13.44|11.37|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|CORESOURCE [1315]|CORESOURCE [131501]|13.44||||13.44|8.76|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|13.44||||13.44|7.39|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|FIRST HEALTH [1375]|BENVEO/UCS [137512]|13.44||||13.44|8.76|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|13.44||||13.44|6.05|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|13.44||||13.44|10.75|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|AETNA [1015]|AETNA ACO WILCO [101532]|13.44||||13.44|8.76|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|13.44||||13.44|6.05|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|13.44||||13.44|9.15|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|13.44||||13.44|9.15|11.37|4.03 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|GEHA [1415]|GEHA - ASA [141503]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BCBS [1155]|TULSA BLUE [115531]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|CHAMPVA [1240]|CHAMP VA [124000]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UMR [2035]|UMR CORE [203505]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|13.44||||13.44||| 100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|13.44||||13.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|2.36|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|6.17|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|6.17|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|6.17|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|2.36|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|6.17|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|||7.71||||7.71|2.31|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|2.36|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|||7.71||||7.71|2.31|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|||7.71||||7.71|2.31|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|6.17|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|||7.71||||7.71|2.31|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|6.17|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|2.36|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|2.36|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|||7.71||||7.71|2.31|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|||7.71||||7.71|2.31|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|2.36|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|5.03|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|5.25|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|7.71||||7.71|6.52|6.52|2.31 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|CIGNA [1260]|CIGNA [126008]|24.63||||24.63|20.83|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|||24.63||||24.63|7.39|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|24.63||||24.63|16.06|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|24.63||||24.63|20.83|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|24.63||||24.63|16.06|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|24.63||||24.63|11.08|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|24.63||||24.63|16.06|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|24.63||||24.63|16.06|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|24.63||||24.63|13.54|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|24.63||||24.63|16.76|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|24.63||||24.63|16.76|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|24.63||||24.63|20.83|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|24.63||||24.63|16.76|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|24.63||||24.63|16.06|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|24.63||||24.63|11.08|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.63||||24.63|7.53|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.63||||24.63|16.06|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.63||||24.63|16.06|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|CORESOURCE [1315]|CORESOURCE [131501]|24.63||||24.63|16.06|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|24.63||||24.63|19.7|20.83|7.39 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UMR [2035]|UMR CORE [203505]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|TULSA BLUE [115531]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|GEHA [1415]|GEHA - ASA [141503]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|24.63||||24.63||| 100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.63||||24.63|16.06|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.63||||24.63|16.06|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|24.63||||24.63|20.83|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|24.63||||24.63|16.06|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|24.63||||24.63|13.54|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|24.63||||24.63|16.06|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|24.63||||24.63|16.76|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|24.63||||24.63|11.08|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|24.63||||24.63|19.7|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|FIRST HEALTH [1375]|BENVEO/UCS [137512]|24.63||||24.63|16.06|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|24.63||||24.63|16.06|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|24.63||||24.63|16.76|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.63||||24.63|7.53|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|||24.63||||24.63|7.39|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|AETNA [1015]|AETNA ACO WILCO [101532]|24.63||||24.63|16.06|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|24.63||||24.63|20.83|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|CIGNA [1260]|CIGNA [126008]|24.63||||24.63|20.83|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|CORESOURCE [1315]|CORESOURCE [131501]|24.63||||24.63|16.06|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|24.63||||24.63|11.08|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|24.63||||24.63|16.76|20.83|7.39 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|GEHA [1415]|GEHA - ASA [141503]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|TULSA BLUE [115531]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UMR [2035]|UMR CORE [203505]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|CHAMPVA [1240]|CHAMP VA [124000]|24.63||||24.63||| 100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|CORESOURCE [1315]|CORESOURCE [131501]|24.63||||24.63|16.06|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|||24.63||||24.63|7.39|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|24.63||||24.63|11.08|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|24.63||||24.63|11.08|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|CIGNA [1260]|CIGNA [126008]|24.63||||24.63|20.83|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|24.63||||24.63|16.06|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|24.63||||24.63|16.76|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|24.63||||24.63|16.06|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|24.63||||24.63|16.76|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|24.63||||24.63|20.83|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|24.63||||24.63|16.06|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|24.63||||24.63|16.06|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|24.63||||24.63|20.83|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|24.63||||24.63|13.54|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|24.63||||24.63|16.76|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.63||||24.63|16.06|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.63||||24.63|16.06|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|24.63||||24.63|16.06|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|24.63||||24.63|19.7|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.63||||24.63|7.53|20.83|7.39 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UMR [2035]|UMR CORE [203505]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|TULSA BLUE [115531]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|GEHA [1415]|GEHA - ASA [141503]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.63||||24.63||| 100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|24.63||||24.63||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA [1260]|CIGNA [126008]|402.29||||402.29|340.34|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|402.29||||402.29|262.29|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|402.29||||402.29|123.06|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|402.29||||402.29|273.8|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|402.29||||402.29|262.29|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|402.29||||402.29|181.03|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|402.29||||402.29|221.26|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CORESOURCE [1315]|CORESOURCE [131501]|402.29||||402.29|262.29|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|402.29||||402.29|262.29|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|402.29||||402.29|321.83|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|402.29||||402.29|273.8|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|BENVEO/UCS [137512]|402.29||||402.29|262.29|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|402.29||||402.29|262.29|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|402.29||||402.29|340.34|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA ACO WILCO [101532]|402.29||||402.29|262.29|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|402.29||||402.29|273.8|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|402.29||||402.29|262.29|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|||402.29||||402.29|120.69|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|402.29||||402.29|340.34|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|402.29||||402.29|181.03|340.34|120.69 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|TULSA BLUE [115531]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GEHA [1415]|GEHA - ASA [141503]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHAMPVA [1240]|CHAMP VA [124000]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|402.29||||402.29||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UMR CORE [203505]|402.29||||402.29||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|||17.63||||17.63|5.29|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|||17.63||||17.63|5.29|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|17.63||||17.63|7.93|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|17.63||||17.63|7.93|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|17.63||||17.63|14.91|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|17.63||||17.63|14.91|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|17.63||||17.63|7.93|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|17.63||||17.63|12|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA [1260]|CIGNA [126008]|17.63||||17.63|14.91|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|17.63||||17.63|12|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|17.63||||17.63|12|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|17.63||||17.63|12|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA [1260]|CIGNA [126008]|17.63||||17.63|14.91|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|17.63||||17.63|9.7|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|17.63||||17.63|14.91|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|17.63||||17.63|7.93|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|17.63||||17.63|9.7|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|17.63||||17.63|14.91|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|17.63||||17.63|12|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|17.63||||17.63|12|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.63||||17.63|5.39|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|17.63||||17.63|14.1|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.63||||17.63|5.39|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|17.63||||17.63|14.1|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.63||||17.63|11.49|14.91|5.29 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR [2035]|UMR CORE [203505]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR [2035]|UMR CORE [203505]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|17.63||||17.63||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.63||||17.63||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22.02||||22.02|14.36|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|22.02||||22.02|17.62|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22.02||||22.02|14.36|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|22.02||||22.02|14.36|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|22.02||||22.02|14.36|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|22.02||||22.02|14.99|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|22.02||||22.02|9.91|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22.02||||22.02|6.74|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|22.02||||22.02|14.36|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|22.02||||22.02|14.99|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|22.02||||22.02|14.36|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|||22.02||||22.02|6.61|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|22.02||||22.02|18.63|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|22.02||||22.02|14.99|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|22.02||||22.02|14.36|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|22.02||||22.02|12.11|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|22.02||||22.02|14.36|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|22.02||||22.02|18.63|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA [1260]|CIGNA [126008]|22.02||||22.02|18.63|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|22.02||||22.02|9.91|18.63|6.61 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR [2035]|UMR CORE [203505]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|22.02||||22.02||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|22.02||||22.02||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|CIGNA [1260]|CIGNA [126008]|53.04||||53.04|44.87|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|53.04||||53.04|34.58|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|53.04||||53.04|23.87|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|53.04||||53.04|44.87|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|53.04||||53.04|36.1|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|53.04||||53.04|34.58|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|53.04||||53.04|36.1|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|53.04||||53.04|23.87|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|53.04||||53.04|34.58|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|AETNA [1015]|AETNA ACO WILCO [101532]|53.04||||53.04|34.58|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|||53.04||||53.04|15.91|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|53.04||||53.04|29.17|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53.04||||53.04|34.58|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|53.04||||53.04|34.58|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53.04||||53.04|34.58|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|53.04||||53.04|44.87|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|CORESOURCE [1315]|CORESOURCE [131501]|53.04||||53.04|34.58|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53.04||||53.04|16.22|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|53.04||||53.04|36.1|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|53.04||||53.04|42.43|44.87|15.91 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|BCBS [1155]|TULSA BLUE [115531]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|UMR [2035]|UMR CORE [203505]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|GEHA [1415]|GEHA - ASA [141503]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|CHAMPVA [1240]|CHAMP VA [124000]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|53.04||||53.04||| 100441|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE TORQUE OLCOTT STERILE DISPOSABLE ACCEPTS .014-.045 IN GUIDEWIRE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|53.04||||53.04||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.70||||106.70|32.64|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|106.70||||106.70|85.36|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|106.70||||106.70|19.98|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131501]|106.70||||106.70|69.57|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|106.70||||106.70|69.57|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|106.70||||106.70|90.27|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|106.70||||106.70|72.62|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|106.70||||106.70|58.69|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|106.70||||106.70|19.98|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|106.70||||106.70|48.02|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|106.70||||106.70|72.62|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|BENVEO/UCS [137512]|106.70||||106.70|69.57|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.70||||106.70|69.57|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|106.70||||106.70|69.57|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|106.70||||106.70|72.62|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|106.70||||106.70|69.57|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|106.70||||106.70|69.57|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.70||||106.70|69.57|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|||106.70||||106.70|32.01|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|106.70||||106.70|90.27|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CIGNA [1260]|CIGNA [126008]|106.70||||106.70|90.27|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|106.70||||106.70|48.02|90.27|19.98 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA - ASA [141503]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UMR [2035]|UMR CORE [203505]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|TULSA BLUE [115531]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|106.70||||106.70||| 10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.70||||106.70||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|17.63||||17.63|14.91|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|||17.63||||17.63|5.29|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CIGNA [1260]|CIGNA [126008]|17.63||||17.63|14.91|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|17.63||||17.63|7.93|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|17.63||||17.63|12|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CIGNA [1260]|CIGNA [126008]|17.63||||17.63|14.91|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|17.63||||17.63|7.93|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|17.63||||17.63|7.93|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|17.63||||17.63|9.7|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|17.63||||17.63|12|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|17.63||||17.63|12|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|17.63||||17.63|12|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|17.63||||17.63|7.93|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|17.63||||17.63|12|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|17.63||||17.63|12|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|17.63||||17.63|9.7|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|17.63||||17.63|14.91|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|17.63||||17.63|14.91|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|17.63||||17.63|14.91|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|||17.63||||17.63|5.29|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.63||||17.63|5.39|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|17.63||||17.63|14.1|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|17.63||||17.63|14.1|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.63||||17.63|5.39|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.63||||17.63|11.49|14.91|5.29 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UMR [2035]|UMR CORE [203505]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UMR [2035]|UMR CORE [203505]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|17.63||||17.63||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.63||||17.63||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2152.80||||2152.80|1722.24|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2152.80||||2152.80|1403.63|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2152.80||||2152.80|1403.63|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2152.80||||2152.80|1821.27|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2152.80||||2152.80|658.54|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|2152.80||||2152.80|1465.2|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2152.80||||2152.80|1403.63|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|CORESOURCE [1315]|CORESOURCE [131501]|2152.80||||2152.80|1403.63|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|2152.80||||2152.80|1184.04|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|2152.80||||2152.80|968.76|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2152.80||||2152.80|1465.2|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|AETNA [1015]|AETNA ACO WILCO [101532]|2152.80||||2152.80|1403.63|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|2152.80||||2152.80|1465.2|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|2152.80||||2152.80|968.76|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|2152.80||||2152.80|1403.63|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|||2152.80||||2152.80|645.84|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2152.80||||2152.80|1821.27|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|2152.80||||2152.80|1403.63|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|CIGNA [1260]|CIGNA [126008]|2152.80||||2152.80|1821.27|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|FIRST HEALTH [1375]|BENVEO/UCS [137512]|2152.80||||2152.80|1403.63|1821.27|645.84 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|GEHA [1415]|GEHA - ASA [141503]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|CHAMPVA [1240]|CHAMP VA [124000]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|BCBS [1155]|TULSA BLUE [115531]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|UMR [2035]|UMR CORE [203505]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2152.80||||2152.80||| 100592|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE COMP 1.3MMX 6H|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2152.80||||2152.80||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|CIGNA [1260]|CIGNA [126008]|144.12||||144.12|121.93|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|144.12||||144.12|93.97|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|144.12||||144.12|93.97|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|144.12||||144.12|64.85|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|144.12||||144.12|98.09|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|144.12||||144.12|64.85|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|144.12||||144.12|121.93|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|FIRST HEALTH [1375]|BENVEO/UCS [137512]|144.12||||144.12|93.97|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|AETNA [1015]|AETNA ACO WILCO [101532]|144.12||||144.12|93.97|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|144.12||||144.12|98.09|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|144.12||||144.12|98.09|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|144.12||||144.12|93.97|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|144.12||||144.12|115.3|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|144.12||||144.12|93.97|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|144.12||||144.12|121.93|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|144.12||||144.12|44.09|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|144.12||||144.12|93.97|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|||144.12||||144.12|43.24|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|144.12||||144.12|79.27|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|CORESOURCE [1315]|CORESOURCE [131501]|144.12||||144.12|93.97|121.93|43.24 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|UMR [2035]|UMR CORE [203505]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BCBS [1155]|TULSA BLUE [115531]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|GEHA [1415]|GEHA - ASA [141503]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|144.12||||144.12||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|CHAMPVA [1240]|CHAMP VA [124000]|144.12||||144.12||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|7.71||||7.71|6.52|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|6.52|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|2.36|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|6.17|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|5.03|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|5.03|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|5.25|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|5.03|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|5.03|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7.71||||7.71|6.52|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|7.71||||7.71|5.03|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|5.03|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|5.25|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|5.25|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|5.03|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|5.03|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|||7.71||||7.71|2.31|6.52|2.31 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UMR [2035]|UMR CORE [203505]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.71||||7.71||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|6.52|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|7.71||||7.71|6.52|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|5.25|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|5.03|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|7.71||||7.71|5.03|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|5.03|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|5.25|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|||7.71||||7.71|2.31|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7.71||||7.71|6.52|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|2.36|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|6.17|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|5.03|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|5.03|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|5.25|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|5.03|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|5.03|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|5.03|6.52|2.31 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UMR [2035]|UMR CORE [203505]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1348.75||||1348.75|412.58|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1348.75||||1348.75|879.39|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1348.75||||1348.75|879.39|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1348.75||||1348.75|917.96|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|CORESOURCE [1315]|CORESOURCE [131501]|1348.75||||1348.75|879.39|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1348.75||||1348.75|879.39|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1348.75||||1348.75|917.96|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1348.75||||1348.75|606.94|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1348.75||||1348.75|741.81|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1348.75||||1348.75|1141.04|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1348.75||||1348.75|879.39|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1348.75||||1348.75|879.39|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1348.75||||1348.75|917.96|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1348.75||||1348.75|606.94|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1348.75||||1348.75|879.39|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1348.75||||1348.75|1079|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|AETNA [1015]|AETNA ACO WILCO [101532]|1348.75||||1348.75|879.39|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|||1348.75||||1348.75|404.62|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1348.75||||1348.75|1141.04|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|CIGNA [1260]|CIGNA [126008]|1348.75||||1348.75|1141.04|1141.04|404.62 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|CHAMPVA [1240]|CHAMP VA [124000]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|BCBS [1155]|TULSA BLUE [115531]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|GEHA [1415]|GEHA - ASA [141503]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|UMR [2035]|UMR CORE [203505]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1348.75||||1348.75||| 100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1348.75||||1348.75||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|||6204.25||||6204.25|1861.27|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|AETNA [1015]|AETNA ACO WILCO [101532]|6204.25||||6204.25|4045.17|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|6204.25||||6204.25|4045.17|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|6204.25||||6204.25|2791.91|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|6204.25||||6204.25|4045.17|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|FIRST HEALTH [1375]|BENVEO/UCS [137512]|6204.25||||6204.25|4045.17|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6204.25||||6204.25|4222.61|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6204.25||||6204.25|5248.8|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|CIGNA [1260]|CIGNA [126008]|6204.25||||6204.25|5248.8|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|6204.25||||6204.25|2791.91|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|CORESOURCE [1315]|CORESOURCE [131501]|6204.25||||6204.25|4045.17|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|6204.25||||6204.25|4222.61|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6204.25||||6204.25|4045.17|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|6204.25||||6204.25|4222.61|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6204.25||||6204.25|4045.17|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6204.25||||6204.25|4045.17|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6204.25||||6204.25|4963.4|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6204.25||||6204.25|1897.88|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6204.25||||6204.25|5248.8|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|6204.25||||6204.25|3412.34|5248.8|1861.27 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UMR [2035]|UMR CORE [203505]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|TULSA BLUE [115531]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|CHAMPVA [1240]|CHAMP VA [124000]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GEHA [1415]|GEHA - ASA [141503]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6204.25||||6204.25||| 100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|6204.25||||6204.25||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.31||||5.31|1.63|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.31||||5.31|3.46|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.31||||5.31|3.46|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5.31||||5.31|2.92|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5.31||||5.31|3.46|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5.31||||5.31|3.62|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|CORESOURCE [1315]|CORESOURCE [131501]|5.31||||5.31|3.46|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5.31||||5.31|2.39|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5.31||||5.31|4.49|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5.31||||5.31|3.46|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5.31||||5.31|3.46|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5.31||||5.31|4.25|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5.31||||5.31|3.62|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5.31||||5.31|3.62|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5.31||||5.31|2.39|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5.31||||5.31|3.46|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|5.31||||5.31|3.46|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|||5.31||||5.31|1.59|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5.31||||5.31|4.49|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|CIGNA [1260]|CIGNA [126008]|5.31||||5.31|4.49|4.49|1.59 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|BCBS [1155]|TULSA BLUE [115531]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|GEHA [1415]|GEHA - ASA [141503]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|UMR [2035]|UMR CORE [203505]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.31||||5.31||| 100945|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLOCK BITE RUBBER ADULT OD60 FR STRAP ELASTIC LATEX FREE DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.31||||5.31||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|246.88||||246.88|111.1|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|246.88||||246.88|168.03|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|246.88||||246.88|160.97|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|246.88||||246.88|168.03|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|CORESOURCE [1315]|CORESOURCE [131501]|246.88||||246.88|160.97|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|246.88||||246.88|168.03|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|246.88||||246.88|160.97|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|246.88||||246.88|111.1|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|246.88||||246.88|208.86|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|246.88||||246.88|135.79|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|246.88||||246.88|160.97|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|246.88||||246.88|160.97|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|246.88||||246.88|160.97|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|246.88||||246.88|160.97|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|246.88||||246.88|197.51|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|AETNA [1015]|AETNA ACO WILCO [101532]|246.88||||246.88|160.97|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|246.88||||246.88|75.52|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|CIGNA [1260]|CIGNA [126008]|246.88||||246.88|208.86|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|||246.88||||246.88|74.06|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|246.88||||246.88|208.86|208.86|74.06 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|UMR [2035]|UMR CORE [203505]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|BCBS [1155]|TULSA BLUE [115531]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|CHAMPVA [1240]|CHAMP VA [124000]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|GEHA [1415]|GEHA - ASA [141503]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|246.88||||246.88||| 100952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ELECTRODE ELECTROSURGICAL 30 D .35 IN LOOP OD24 FR HIGH FREQUENCY WIRE STERILE DISPOSABLE RESECTOSCOPE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|246.88||||246.88||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|558.17||||558.17|170.74|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|558.17||||558.17|26.25|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|558.17||||558.17|363.93|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|558.17||||558.17|363.93|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|558.17||||558.17|472.21|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|558.17||||558.17|379.89|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|558.17||||558.17|363.93|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|558.17||||558.17|363.93|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|558.17||||558.17|446.54|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|558.17||||558.17|26.25|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|558.17||||558.17|379.89|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|558.17||||558.17|306.99|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|558.17||||558.17|363.93|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|558.17||||558.17|363.93|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|558.17||||558.17|251.18|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|558.17||||558.17|251.18|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|558.17||||558.17|379.89|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|558.17||||558.17|363.93|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|558.17||||558.17|363.93|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|||558.17||||558.17|167.45|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|558.17||||558.17|472.21|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|558.17||||558.17|472.21|472.21|26.25 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA - ASA [141503]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|TULSA BLUE [115531]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|558.17||||558.17||| 10100|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|558.17||||558.17||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|CIGNA [1260]|CIGNA [126008]|5.56||||5.56|4.71|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|AETNA [1015]|AETNA ACO WILCO [101532]|5.56||||5.56|3.63|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5.56||||5.56|3.79|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5.56||||5.56|2.5|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5.56||||5.56|3.63|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5.56||||5.56|2.5|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5.56||||5.56|3.79|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5.56||||5.56|3.63|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|CORESOURCE [1315]|CORESOURCE [131501]|5.56||||5.56|3.63|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5.56||||5.56|3.79|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5.56||||5.56|3.63|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5.56||||5.56|4.71|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5.56||||5.56|4.71|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.56||||5.56|3.63|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5.56||||5.56|3.63|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5.56||||5.56|3.06|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.56||||5.56|3.63|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5.56||||5.56|4.45|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.56||||5.56|1.7|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|||5.56||||5.56|1.67|4.71|1.67 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|BCBS [1155]|TULSA BLUE [115531]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|UMR [2035]|UMR CORE [203505]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|CHAMPVA [1240]|CHAMP VA [124000]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|GEHA [1415]|GEHA - ASA [141503]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.56||||5.56||| 101123|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SHILEY PEDIATRIC ID3.0 MM NASAL ORAL UNCUFF FULL MAGILL CURVE MURPHY EYE DISTAL TIP REFERENCE LINE STERILE LATEX FREE DISPOSABLE CLEAR|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5.56||||5.56||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6.88||||6.88|2.1|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6.88||||6.88|4.48|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6.88||||6.88|5.5|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6.88||||6.88|4.48|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6.88||||6.88|5.82|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6.88||||6.88|4.48|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|CORESOURCE [1315]|CORESOURCE [131501]|6.88||||6.88|4.48|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|6.88||||6.88|4.68|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|6.88||||6.88|3.78|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|6.88||||6.88|3.09|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|6.88||||6.88|4.48|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|6.88||||6.88|3.09|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6.88||||6.88|4.68|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|6.88||||6.88|4.68|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|6.88||||6.88|4.48|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|6.88||||6.88|4.48|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6.88||||6.88|5.82|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|||6.88||||6.88|2.07|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|CIGNA [1260]|CIGNA [126008]|6.88||||6.88|5.82|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|6.88||||6.88|4.48|5.82|2.07 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|GEHA [1415]|GEHA - ASA [141503]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|BCBS [1155]|TULSA BLUE [115531]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|UMR [2035]|UMR CORE [203505]|6.88||||6.88||| 101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|CIGNA [1260]|CIGNA [126008]|6.88||||6.88|5.82|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6.88||||6.88|5.82|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|6.88||||6.88|4.48|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|6.88||||6.88|4.68|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|6.88||||6.88|3.09|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|6.88||||6.88|4.48|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|6.88||||6.88|4.48|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|6.88||||6.88|4.48|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6.88||||6.88|4.68|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|||6.88||||6.88|2.07|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|6.88||||6.88|3.09|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6.88||||6.88|4.48|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|CORESOURCE [1315]|CORESOURCE [131501]|6.88||||6.88|4.48|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6.88||||6.88|5.82|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|6.88||||6.88|3.78|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6.88||||6.88|4.48|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6.88||||6.88|5.5|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6.88||||6.88|4.48|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6.88||||6.88|2.1|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|6.88||||6.88|4.68|5.82|2.07 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|UMR [2035]|UMR CORE [203505]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|BCBS [1155]|TULSA BLUE [115531]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|GEHA [1415]|GEHA - ASA [141503]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|6.88||||6.88||| 101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6.88||||6.88||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.86||||12.86|3.93|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.86||||12.86|3.93|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|12.86||||12.86|10.29|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|12.86||||12.86|10.29|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|12.86||||12.86|10.88|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|12.86||||12.86|7.07|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|12.86||||12.86|8.75|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|12.86||||12.86|8.75|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|12.86||||12.86|7.07|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|12.86||||12.86|8.75|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|12.86||||12.86|8.75|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|12.86||||12.86|5.79|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|12.86||||12.86|5.79|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|12.86||||12.86|10.88|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|12.86||||12.86|8.75|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|12.86||||12.86|8.75|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|12.86||||12.86|8.38|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|||12.86||||12.86|3.86|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|||12.86||||12.86|3.86|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|12.86||||12.86|5.79|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|12.86||||12.86|10.88|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|12.86||||12.86|10.88|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CIGNA [1260]|CIGNA [126008]|12.86||||12.86|10.88|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CIGNA [1260]|CIGNA [126008]|12.86||||12.86|10.88|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|12.86||||12.86|5.79|10.88|3.86 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UMR [2035]|UMR CORE [203505]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UMR [2035]|UMR CORE [203505]|12.86||||12.86||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.86||||12.86||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|||3.31||||3.31|0.99|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|3.31||||3.31|2.8|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3.31||||3.31|2.16|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|FIRST HEALTH [1375]|BENVEO/UCS [137512]|3.31||||3.31|2.16|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3.31||||3.31|1.49|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3.31||||3.31|2.25|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|CIGNA [1260]|CIGNA [126008]|3.31||||3.31|2.8|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3.31||||3.31|2.25|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|3.31||||3.31|2.8|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3.31||||3.31|2.16|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3.31||||3.31|2.16|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3.31||||3.31|2.25|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3.31||||3.31|1.49|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3.31||||3.31|2.16|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3.31||||3.31|1.01|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3.31||||3.31|2.65|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3.31||||3.31|1.82|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3.31||||3.31|2.16|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|CORESOURCE [1315]|CORESOURCE [131501]|3.31||||3.31|2.16|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|AETNA [1015]|AETNA ACO WILCO [101532]|3.31||||3.31|2.16|2.8|0.99 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|UMR [2035]|UMR CORE [203505]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|BCBS [1155]|TULSA BLUE [115531]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|GEHA [1415]|GEHA - ASA [141503]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|CHAMPVA [1240]|CHAMP VA [124000]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3.31||||3.31||| 101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3.31||||3.31||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1596.50||||1596.50|488.37|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1596.50||||1596.50|1277.2|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1596.50||||1596.50|1040.92|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1596.50||||1596.50|1350.64|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1596.50||||1596.50|878.08|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1596.50||||1596.50|1040.92|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|CORESOURCE [1315]|CORESOURCE [131501]|1596.50||||1596.50|1040.92|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1596.50||||1596.50|1086.58|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1596.50||||1596.50|1040.92|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1596.50||||1596.50|718.43|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1596.50||||1596.50|1040.92|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1596.50||||1596.50|1040.92|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1596.50||||1596.50|1086.58|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1596.50||||1596.50|718.43|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1596.50||||1596.50|1086.58|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1596.50||||1596.50|1040.92|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|AETNA [1015]|AETNA ACO WILCO [101532]|1596.50||||1596.50|1040.92|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1596.50||||1596.50|1350.64|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|||1596.50||||1596.50|478.95|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|CIGNA [1260]|CIGNA [126008]|1596.50||||1596.50|1350.64|1350.64|478.95 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|CHAMPVA [1240]|CHAMP VA [124000]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|GEHA [1415]|GEHA - ASA [141503]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|BCBS [1155]|TULSA BLUE [115531]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1596.50||||1596.50||| 101368|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL CALIB AOS 13.5MM|UMR [2035]|UMR CORE [203505]|1596.50||||1596.50||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|CIGNA [1260]|CIGNA [126008]|208.00||||208.00|175.97|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|AETNA [1015]|AETNA ACO WILCO [101532]|208.00||||208.00|135.62|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|208.00||||208.00|175.97|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|208.00||||208.00|135.62|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|208.00||||208.00|93.6|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|FIRST HEALTH [1375]|BENVEO/UCS [137512]|208.00||||208.00|135.62|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|208.00||||208.00|93.6|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|208.00||||208.00|141.56|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|208.00||||208.00|141.56|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|||208.00||||208.00|62.4|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|208.00||||208.00|141.56|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|208.00||||208.00|114.4|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|208.00||||208.00|135.62|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|208.00||||208.00|135.62|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|208.00||||208.00|175.97|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|208.00||||208.00|135.62|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|208.00||||208.00|135.62|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|CORESOURCE [1315]|CORESOURCE [131501]|208.00||||208.00|135.62|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|208.00||||208.00|166.4|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|208.00||||208.00|63.63|175.97|62.4 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|UMR [2035]|UMR CORE [203505]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|BCBS [1155]|TULSA BLUE [115531]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|CHAMPVA [1240]|CHAMP VA [124000]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|GEHA [1415]|GEHA - ASA [141503]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|208.00||||208.00||| 101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|208.00||||208.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28.00||||28.00|8.57|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28.00||||28.00|18.26|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|28.00||||28.00|23.69|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|28.00||||28.00|15.4|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|28.00||||28.00|19.06|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|28.00||||28.00|18.26|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|CORESOURCE [1315]|CORESOURCE [131501]|28.00||||28.00|18.26|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|28.00||||28.00|19.06|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|FIRST HEALTH [1375]|BENVEO/UCS [137512]|28.00||||28.00|18.26|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|28.00||||28.00|22.4|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28.00||||28.00|18.26|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|28.00||||28.00|18.26|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|28.00||||28.00|12.6|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|28.00||||28.00|19.06|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|28.00||||28.00|12.6|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|28.00||||28.00|18.26|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|AETNA [1015]|AETNA ACO WILCO [101532]|28.00||||28.00|18.26|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|28.00||||28.00|23.69|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|||28.00||||28.00|8.4|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|CIGNA [1260]|CIGNA [126008]|28.00||||28.00|23.69|23.69|8.4 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|GEHA [1415]|GEHA - ASA [141503]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|CHAMPVA [1240]|CHAMP VA [124000]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|BCBS [1155]|TULSA BLUE [115531]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|UMR [2035]|UMR CORE [203505]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|28.00||||28.00||| 101451|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE MULTIPASS CHROMIC 6-0 PS-4 L18 IN MONOFILAMENT BROWN|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|28.00||||28.00||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|||54.70||||54.70|16.41|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|AETNA [1015]|AETNA ACO WILCO [101532]|54.70||||54.70|35.67|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|54.70||||54.70|35.67|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|54.70||||54.70|24.62|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|54.70||||54.70|35.67|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|54.70||||54.70|24.62|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|54.70||||54.70|46.28|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|CORESOURCE [1315]|CORESOURCE [131501]|54.70||||54.70|35.67|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|54.70||||54.70|35.67|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|CIGNA [1260]|CIGNA [126008]|54.70||||54.70|46.28|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|54.70||||54.70|37.23|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|54.70||||54.70|35.67|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|54.70||||54.70|37.23|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|54.70||||54.70|30.09|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|54.70||||54.70|46.28|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54.70||||54.70|35.67|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|54.70||||54.70|37.23|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|54.70||||54.70|43.76|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54.70||||54.70|35.67|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54.70||||54.70|16.73|46.28|16.41 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|UMR [2035]|UMR CORE [203505]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|BCBS [1155]|TULSA BLUE [115531]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|CHAMPVA [1240]|CHAMP VA [124000]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|GEHA [1415]|GEHA - ASA [141503]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|54.70||||54.70||| 101452|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL SABRELOC 6-0 S-14 L12 IN 2 ARM BRAID COATED VIOLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54.70||||54.70||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|57.30||||57.30|37.36|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.30||||57.30|17.53|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.30||||57.30|37.36|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.30||||57.30|37.36|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|57.30||||57.30|48.48|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|57.30||||57.30|31.52|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|57.30||||57.30|39|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|CORESOURCE [1315]|CORESOURCE [131501]|57.30||||57.30|37.36|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|57.30||||57.30|37.36|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|57.30||||57.30|37.36|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|57.30||||57.30|45.84|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|57.30||||57.30|25.79|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|57.30||||57.30|25.79|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|57.30||||57.30|39|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|57.30||||57.30|39|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|57.30||||57.30|37.36|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|AETNA [1015]|AETNA ACO WILCO [101532]|57.30||||57.30|37.36|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|57.30||||57.30|48.48|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|||57.30||||57.30|17.19|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|CIGNA [1260]|CIGNA [126008]|57.30||||57.30|48.48|48.48|17.19 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|GEHA [1415]|GEHA - ASA [141503]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|CHAMPVA [1240]|CHAMP VA [124000]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|BCBS [1155]|TULSA BLUE [115531]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|UMR [2035]|UMR CORE [203505]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|57.30||||57.30||| 101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.30||||57.30||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|||30.50||||30.50|9.15|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|30.50||||30.50|25.8|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|AETNA [1015]|AETNA ACO WILCO [101532]|30.50||||30.50|19.89|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|30.50||||30.50|20.76|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|30.50||||30.50|19.89|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|30.50||||30.50|19.89|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|30.50||||30.50|13.73|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|30.50||||30.50|13.73|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|CIGNA [1260]|CIGNA [126008]|30.50||||30.50|25.8|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|CORESOURCE [1315]|CORESOURCE [131501]|30.50||||30.50|19.89|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|30.50||||30.50|20.76|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|30.50||||30.50|19.89|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30.50||||30.50|9.33|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30.50||||30.50|19.89|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|30.50||||30.50|24.4|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30.50||||30.50|19.89|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|30.50||||30.50|25.8|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|30.50||||30.50|16.78|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|30.50||||30.50|20.76|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|30.50||||30.50|19.89|25.8|9.15 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|BCBS [1155]|TULSA BLUE [115531]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|UMR [2035]|UMR CORE [203505]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|CHAMPVA [1240]|CHAMP VA [124000]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|GEHA [1415]|GEHA - ASA [141503]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30.50||||30.50||| 101454|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 2-0 L18 IN BRAID TIES 3 STRAND COATED VIOLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|30.50||||30.50||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.00||||11.00|3.36|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.00||||11.00|7.17|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|11.00||||11.00|8.8|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.00||||11.00|7.17|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|11.00||||11.00|9.31|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|11.00||||11.00|6.05|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|11.00||||11.00|7.49|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|11.00||||11.00|7.17|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|CORESOURCE [1315]|CORESOURCE [131501]|11.00||||11.00|7.17|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|11.00||||11.00|7.49|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|11.00||||11.00|7.17|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|11.00||||11.00|7.17|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|11.00||||11.00|4.95|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|11.00||||11.00|7.49|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|11.00||||11.00|4.95|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|11.00||||11.00|7.17|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|11.00||||11.00|7.17|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|11.00||||11.00|9.31|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|||11.00||||11.00|3.3|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|CIGNA [1260]|CIGNA [126008]|11.00||||11.00|9.31|9.31|3.3 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|GEHA [1415]|GEHA - ASA [141503]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|BCBS [1155]|TULSA BLUE [115531]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|UMR [2035]|UMR CORE [203505]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.00||||11.00||| 101462|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|SPIROMETER INCENTIVE COACH 2 HUDSON RCI BALL 200-1200 ML 2 CHAMBER LUNG VOLUME EXERCISER ADJUSTABLE SET DISPOSABLE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|11.00||||11.00||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|408.07||||408.07|266.06|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|408.07||||408.07|124.83|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|||408.07||||408.07|122.42|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|AETNA [1015]|AETNA ACO WILCO [101532]|408.07||||408.07|266.06|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|408.07||||408.07|266.06|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|408.07||||408.07|277.73|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|408.07||||408.07|183.63|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|408.07||||408.07|266.06|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|FIRST HEALTH [1375]|BENVEO/UCS [137512]|408.07||||408.07|266.06|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|408.07||||408.07|183.63|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|408.07||||408.07|277.73|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|CORESOURCE [1315]|CORESOURCE [131501]|408.07||||408.07|266.06|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|408.07||||408.07|345.23|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|408.07||||408.07|266.06|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|CIGNA [1260]|CIGNA [126008]|408.07||||408.07|345.23|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|408.07||||408.07|277.73|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|408.07||||408.07|224.44|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|408.07||||408.07|345.23|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|408.07||||408.07|266.06|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|408.07||||408.07|326.46|345.23|122.42 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|UMR [2035]|UMR CORE [203505]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|BCBS [1155]|TULSA BLUE [115531]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|CHAMPVA [1240]|CHAMP VA [124000]|408.07||||408.07||| 101463|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SYSTEM CASTING TCC-EZ L3 IN NO BOOT|GEHA [1415]|GEHA - ASA [141503]|408.07||||408.07||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.90||||86.90|26.58|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|86.90||||86.90|69.52|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|86.90||||86.90|69.52|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|86.90||||86.90|3.1|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|86.90||||86.90|3.1|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|86.90||||86.90|73.52|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|86.90||||86.90|73.52|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|86.90||||86.90|47.8|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|86.90||||86.90|47.8|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|86.90||||86.90|59.14|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|86.90||||86.90|59.14|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|86.90||||86.90|3.1|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|86.90||||86.90|3.1|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|86.90||||86.90|59.14|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|86.90||||86.90|59.14|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|86.90||||86.90|39.11|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|86.90||||86.90|39.11|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.90||||86.90|26.58|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|86.90||||86.90|39.11|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|86.90||||86.90|39.11|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|86.90||||86.90|59.14|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|86.90||||86.90|59.14|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|86.90||||86.90|56.66|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|||86.90||||86.90|26.07|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|||86.90||||86.90|26.07|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|86.90||||86.90|73.52|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|86.90||||86.90|73.52|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|86.90||||86.90|73.52|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|86.90||||86.90|73.52|73.52|3.1 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA - ASA [141503]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA - ASA [141503]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|TULSA BLUE [115531]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|TULSA BLUE [115531]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|86.90||||86.90||| 10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|86.90||||86.90|73.52|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|86.90||||86.90|73.52|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|||86.90||||86.90|26.07|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|86.90||||86.90|56.66|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|86.90||||86.90|59.14|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|86.90||||86.90|56.66|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|86.90||||86.90|56.66|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|86.90||||86.90|39.11|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|86.90||||86.90|59.14|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|86.90||||86.90|1.55|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|86.90||||86.90|56.66|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|86.90||||86.90|56.66|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|86.90||||86.90|59.14|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|86.90||||86.90|47.8|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|86.90||||86.90|39.11|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|86.90||||86.90|73.52|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|86.90||||86.90|56.66|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.90||||86.90|56.66|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|86.90||||86.90|1.55|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.90||||86.90|56.66|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|86.90||||86.90|69.52|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.90||||86.90|26.58|73.52|1.55 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|TULSA BLUE [115531]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA - ASA [141503]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|86.90||||86.90||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|86.90||||86.90||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|2.36|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|6.17|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|6.17|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7.71||||7.71|6.52|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7.71||||7.71|6.52|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|5.25|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|5.25|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|5.25|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|5.25|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|2.36|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|5.25|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|5.25|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|5.03|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|||7.71||||7.71|2.31|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|||7.71||||7.71|2.31|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|7.71||||7.71|6.52|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|7.71||||7.71|6.52|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|6.52|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|6.52|6.52|2.31 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|CIGNA [1260]|CIGNA [126008]|22.02||||22.02|18.63|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|||22.02||||22.02|6.61|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|22.02||||22.02|14.36|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|22.02||||22.02|14.36|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|22.02||||22.02|14.99|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|22.02||||22.02|9.91|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|22.02||||22.02|14.36|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|22.02||||22.02|9.91|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|22.02||||22.02|14.99|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|22.02||||22.02|14.36|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|22.02||||22.02|14.36|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|22.02||||22.02|14.36|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|22.02||||22.02|14.99|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|22.02||||22.02|12.11|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|22.02||||22.02|18.63|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|22.02||||22.02|18.63|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22.02||||22.02|14.36|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22.02||||22.02|14.36|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|22.02||||22.02|17.62|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22.02||||22.02|6.74|18.63|6.61 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|UMR [2035]|UMR CORE [203505]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|22.02||||22.02||| 10209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 5 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|22.02||||22.02||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|17.44||||17.44|13.95|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.44||||17.44|11.37|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.44||||17.44|11.37|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|17.44||||17.44|9.59|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|17.44||||17.44|11.37|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|17.44||||17.44|11.87|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|CORESOURCE [1315]|CORESOURCE [131501]|17.44||||17.44|11.37|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|17.44||||17.44|14.75|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|17.44||||17.44|11.87|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|17.44||||17.44|7.85|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.44||||17.44|5.33|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|17.44||||17.44|11.37|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|17.44||||17.44|11.37|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|17.44||||17.44|11.87|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|17.44||||17.44|7.85|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|17.44||||17.44|11.37|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|17.44||||17.44|11.37|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|||17.44||||17.44|5.23|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|17.44||||17.44|14.75|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|CIGNA [1260]|CIGNA [126008]|17.44||||17.44|14.75|14.75|5.23 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|GEHA [1415]|GEHA - ASA [141503]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|BCBS [1155]|TULSA BLUE [115531]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|17.44||||17.44||| 10217|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 5 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|UMR [2035]|UMR CORE [203505]|17.44||||17.44||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|CIGNA [1260]|CIGNA [126008]|20.06||||20.06|16.97|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|20.06||||20.06|16.97|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|20.06||||20.06|13.08|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|20.06||||20.06|13.08|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|20.06||||20.06|9.03|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|20.06||||20.06|13.65|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|20.06||||20.06|13.08|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|20.06||||20.06|9.03|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|20.06||||20.06|13.65|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|CORESOURCE [1315]|CORESOURCE [131501]|20.06||||20.06|13.08|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|20.06||||20.06|13.08|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|20.06||||20.06|13.65|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|20.06||||20.06|13.08|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|20.06||||20.06|16.97|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|20.06||||20.06|11.03|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|||20.06||||20.06|6.02|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20.06||||20.06|13.08|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20.06||||20.06|13.08|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|20.06||||20.06|16.05|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20.06||||20.06|6.14|16.97|6.02 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|UMR [2035]|UMR CORE [203505]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|BCBS [1155]|TULSA BLUE [115531]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|GEHA [1415]|GEHA - ASA [141503]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|20.06||||20.06||| 10219|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL BARDEX LUBRICATH NATURAL RUBBER HYDROGEL OD16 FR 30 CC FOLEY 2 WAY BALLOON STERILE LATEX DISPOSABLE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|20.06||||20.06||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|675.41||||675.41|206.61|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|675.41||||675.41|540.33|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|675.41||||675.41|440.37|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|675.41||||675.41|440.37|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|675.41||||675.41|571.4|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|675.41||||675.41|440.37|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|675.41||||675.41|459.69|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|675.41||||675.41|440.37|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|675.41||||675.41|371.48|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|675.41||||675.41|459.69|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|675.41||||675.41|303.94|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|675.41||||675.41|440.37|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|675.41||||675.41|440.37|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|675.41||||675.41|459.69|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|675.41||||675.41|303.94|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|675.41||||675.41|440.37|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|675.41||||675.41|440.37|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|||675.41||||675.41|202.62|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|675.41||||675.41|571.4|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|CIGNA [1260]|CIGNA [126008]|675.41||||675.41|571.4|571.4|202.62 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|UMR [2035]|UMR CORE [203505]|675.41||||675.41||| 102337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL SHORT L216 MM OD4.3 MM LOCK NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|675.41||||675.41||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CIGNA [1260]|CIGNA [126008]|25.33||||25.33|21.43|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|25.33||||25.33|21.43|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|25.33||||25.33|21.43|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|||25.33||||25.33|7.6|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|||25.33||||25.33|7.6|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|25.33||||25.33|17.24|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|25.33||||25.33|11.4|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|25.33||||25.33|11.4|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|25.33||||25.33|11.4|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|25.33||||25.33|17.24|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|25.33||||25.33|17.24|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|25.33||||25.33|17.24|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|25.33||||25.33|17.24|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|25.33||||25.33|11.4|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|25.33||||25.33|13.93|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|25.33||||25.33|13.93|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|25.33||||25.33|21.43|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|25.33||||25.33|21.43|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|25.33||||25.33|17.24|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.33||||25.33|16.52|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|25.33||||25.33|20.26|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|25.33||||25.33|20.26|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.33||||25.33|7.75|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CIGNA [1260]|CIGNA [126008]|25.33||||25.33|21.43|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.33||||25.33|7.75|21.43|7.6 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UMR [2035]|UMR CORE [203505]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UMR [2035]|UMR CORE [203505]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|25.33||||25.33||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|25.33||||25.33||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|395.20||||395.20|316.16|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|395.20||||395.20|257.67|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|395.20||||395.20|334.34|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|395.20||||395.20|257.67|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|CORESOURCE [1315]|CORESOURCE [131501]|395.20||||395.20|257.67|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|395.20||||395.20|268.97|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|395.20||||395.20|217.36|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|395.20||||395.20|268.97|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|395.20||||395.20|257.67|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|395.20||||395.20|177.84|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|395.20||||395.20|120.89|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|395.20||||395.20|257.67|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|395.20||||395.20|257.67|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|395.20||||395.20|268.97|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|395.20||||395.20|177.84|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|395.20||||395.20|257.67|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|AETNA [1015]|AETNA ACO WILCO [101532]|395.20||||395.20|257.67|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|||395.20||||395.20|118.56|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|395.20||||395.20|334.34|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|CIGNA [1260]|CIGNA [126008]|395.20||||395.20|334.34|334.34|118.56 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|GEHA [1415]|GEHA - ASA [141503]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|CHAMPVA [1240]|CHAMP VA [124000]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|BCBS [1155]|TULSA BLUE [115531]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|395.20||||395.20||| 102380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L24 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|UMR [2035]|UMR CORE [203505]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|CIGNA [1260]|CIGNA [126008]|395.20||||395.20|334.34|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|395.20||||395.20|334.34|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|AETNA [1015]|AETNA ACO WILCO [101532]|395.20||||395.20|257.67|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|395.20||||395.20|257.67|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|395.20||||395.20|177.84|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|395.20||||395.20|268.97|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|395.20||||395.20|257.67|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|395.20||||395.20|177.84|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|395.20||||395.20|268.97|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|CORESOURCE [1315]|CORESOURCE [131501]|395.20||||395.20|257.67|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|395.20||||395.20|268.97|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|395.20||||395.20|257.67|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|395.20||||395.20|334.34|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|395.20||||395.20|217.36|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|395.20||||395.20|257.67|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|||395.20||||395.20|118.56|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|395.20||||395.20|257.67|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|395.20||||395.20|257.67|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|395.20||||395.20|316.16|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|395.20||||395.20|120.89|334.34|118.56 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|UMR [2035]|UMR CORE [203505]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|BCBS [1155]|TULSA BLUE [115531]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|CHAMPVA [1240]|CHAMP VA [124000]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|GEHA [1415]|GEHA - ASA [141503]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|395.20||||395.20||| 102381|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE POLARUS 3 L26 MM OD3.5 MM HUMERUS LOW PROFILE HEXALOBE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|395.20||||395.20||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|97.86||||97.86|29.94|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|97.86||||97.86|78.29|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|97.86||||97.86|63.81|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|97.86||||97.86|63.81|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|97.86||||97.86|53.83|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|97.86||||97.86|82.79|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|97.86||||97.86|63.81|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|97.86||||97.86|66.61|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|CORESOURCE [1315]|CORESOURCE [131501]|97.86||||97.86|63.81|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|97.86||||97.86|66.61|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|97.86||||97.86|44.04|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|97.86||||97.86|63.81|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|97.86||||97.86|63.81|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|97.86||||97.86|66.61|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|97.86||||97.86|44.04|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|97.86||||97.86|63.81|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|97.86||||97.86|63.81|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|||97.86||||97.86|29.36|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|97.86||||97.86|82.79|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|CIGNA [1260]|CIGNA [126008]|97.86||||97.86|82.79|82.79|29.36 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|BCBS [1155]|TULSA BLUE [115531]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|GEHA [1415]|GEHA - ASA [141503]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|UMR [2035]|UMR CORE [203505]|97.86||||97.86||| 102396|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEAL ENDOSCOPIC ADJUSTABLE BIOPSY PORT Y ADAPTER STERILE LATEX FREE DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|97.86||||97.86||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CIGNA [1260]|CIGNA [126008]|13.66||||13.66|11.56|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|||13.66||||13.66|4.1|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|13.66||||13.66|8.91|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|13.66||||13.66|8.91|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|13.66||||13.66|9.3|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|13.66||||13.66|8.91|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|13.66||||13.66|6.15|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|13.66||||13.66|9.3|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131501]|13.66||||13.66|8.91|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|13.66||||13.66|8.91|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|13.66||||13.66|8.91|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|13.66||||13.66|9.3|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|13.66||||13.66|6.15|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|13.66||||13.66|7.51|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|13.66||||13.66|11.56|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.66||||13.66|8.91|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|13.66||||13.66|11.56|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.66||||13.66|8.91|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|13.66||||13.66|10.93|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.66||||13.66|4.18|11.56|4.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UMR [2035]|UMR CORE [203505]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|TULSA BLUE [115531]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|GEHA [1415]|GEHA - ASA [141503]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|13.66||||13.66||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|13.66||||13.66||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|395.20||||395.20|120.89|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|395.20||||395.20|316.16|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|395.20||||395.20|257.67|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|395.20||||395.20|257.67|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|395.20||||395.20|217.36|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|395.20||||395.20|257.67|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|395.20||||395.20|268.97|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|395.20||||395.20|257.67|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|395.20||||395.20|334.34|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|395.20||||395.20|268.97|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|395.20||||395.20|177.84|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|395.20||||395.20|257.67|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|395.20||||395.20|257.67|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|395.20||||395.20|268.97|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|395.20||||395.20|177.84|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|395.20||||395.20|257.67|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|395.20||||395.20|257.67|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|||395.20||||395.20|118.56|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|395.20||||395.20|334.34|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|CIGNA [1260]|CIGNA [126008]|395.20||||395.20|334.34|334.34|118.56 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|UMR [2035]|UMR CORE [203505]|395.20||||395.20||| 102552|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L14 MM OD2.7 MM HEXALOBE NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|CIGNA [1260]|CIGNA [126008]|395.20||||395.20|334.34|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|||395.20||||395.20|118.56|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|395.20||||395.20|257.67|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|395.20||||395.20|177.84|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|395.20||||395.20|268.97|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|395.20||||395.20|257.67|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|395.20||||395.20|257.67|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|395.20||||395.20|177.84|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|395.20||||395.20|268.97|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|395.20||||395.20|257.67|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|395.20||||395.20|268.97|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|395.20||||395.20|257.67|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|395.20||||395.20|334.34|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|395.20||||395.20|257.67|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|395.20||||395.20|217.36|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|395.20||||395.20|334.34|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|395.20||||395.20|257.67|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|395.20||||395.20|257.67|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|395.20||||395.20|316.16|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|395.20||||395.20|120.89|334.34|118.56 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|UMR [2035]|UMR CORE [203505]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|395.20||||395.20||| 102553|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE L10 MM OD2.7 MM HEXALOBE NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|395.20||||395.20||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1369.50||||1369.50|418.93|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1369.50||||1369.50|892.91|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1369.50||||1369.50|753.23|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1369.50||||1369.50|1158.6|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1369.50||||1369.50|932.08|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|CORESOURCE [1315]|CORESOURCE [131501]|1369.50||||1369.50|892.91|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1369.50||||1369.50|892.91|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1369.50||||1369.50|932.08|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1369.50||||1369.50|616.28|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1369.50||||1369.50|892.91|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1369.50||||1369.50|1095.6|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1369.50||||1369.50|892.91|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1369.50||||1369.50|892.91|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1369.50||||1369.50|932.08|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1369.50||||1369.50|616.28|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1369.50||||1369.50|892.91|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|AETNA [1015]|AETNA ACO WILCO [101532]|1369.50||||1369.50|892.91|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|||1369.50||||1369.50|410.85|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1369.50||||1369.50|1158.6|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|CIGNA [1260]|CIGNA [126008]|1369.50||||1369.50|1158.6|1158.6|410.85 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|GEHA [1415]|GEHA - ASA [141503]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|CHAMPVA [1240]|CHAMP VA [124000]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|BCBS [1155]|TULSA BLUE [115531]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|UMR [2035]|UMR CORE [203505]|1369.50||||1369.50||| 102556|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL QUICK RELEASE 2.7 MM SCREW|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1369.50||||1369.50||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|CIGNA [1260]|CIGNA [126008]|205.00||||205.00|173.43|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|205.00||||205.00|173.43|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|||205.00||||205.00|61.5|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|205.00||||205.00|133.66|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|205.00||||205.00|139.52|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|205.00||||205.00|133.66|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|205.00||||205.00|133.66|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|205.00||||205.00|92.25|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|205.00||||205.00|139.52|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|205.00||||205.00|133.66|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|205.00||||205.00|139.52|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|205.00||||205.00|133.66|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|205.00||||205.00|92.25|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|205.00||||205.00|173.43|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|205.00||||205.00|112.75|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|205.00||||205.00|133.66|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|205.00||||205.00|133.66|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|205.00||||205.00|133.66|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|205.00||||205.00|164|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|205.00||||205.00|62.71|173.43|61.5 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|UMR [2035]|UMR CORE [203505]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|205.00||||205.00||| 102558|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE LOQTEQ TITANIUM T15 L38 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|205.00||||205.00|62.71|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|205.00||||205.00|164|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|205.00||||205.00|133.66|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|205.00||||205.00|133.66|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|205.00||||205.00|112.75|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|205.00||||205.00|133.66|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|205.00||||205.00|139.52|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|205.00||||205.00|133.66|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|205.00||||205.00|173.43|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|205.00||||205.00|139.52|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|205.00||||205.00|92.25|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|205.00||||205.00|133.66|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|205.00||||205.00|133.66|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|205.00||||205.00|139.52|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|205.00||||205.00|92.25|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|205.00||||205.00|133.66|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|205.00||||205.00|133.66|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|||205.00||||205.00|61.5|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|205.00||||205.00|173.43|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|CIGNA [1260]|CIGNA [126008]|205.00||||205.00|173.43|173.43|61.5 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|UMR [2035]|UMR CORE [203505]|205.00||||205.00||| 102563|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM T15 L30 MM OD3.5 MM CORTICAL SELF TAP NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|205.00||||205.00||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|CIGNA [1260]|CIGNA [126008]|1341.60||||1341.60|1134.99|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1341.60||||1341.60|1134.99|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1341.60||||1341.60|874.72|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|AETNA [1015]|AETNA ACO WILCO [101532]|1341.60||||1341.60|874.72|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1341.60||||1341.60|603.72|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1341.60||||1341.60|913.09|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1341.60||||1341.60|874.72|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1341.60||||1341.60|603.72|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1341.60||||1341.60|913.09|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|CORESOURCE [1315]|CORESOURCE [131501]|1341.60||||1341.60|874.72|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1341.60||||1341.60|913.09|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1341.60||||1341.60|874.72|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1341.60||||1341.60|874.72|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1341.60||||1341.60|1134.99|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1341.60||||1341.60|737.88|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|||1341.60||||1341.60|402.48|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1341.60||||1341.60|874.72|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1341.60||||1341.60|874.72|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1341.60||||1341.60|1073.28|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1341.60||||1341.60|410.4|1134.99|402.48 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|UMR [2035]|UMR CORE [203505]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|BCBS [1155]|TULSA BLUE [115531]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|CHAMPVA [1240]|CHAMP VA [124000]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|GEHA [1415]|GEHA - ASA [141503]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1341.60||||1341.60||| 102590|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE CANCELLOUS 1-4MM 30CC|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1341.60||||1341.60||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3268.13||||3268.13|999.72|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3268.13||||3268.13|2130.82|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3268.13||||3268.13|2130.82|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3268.13||||3268.13|1797.47|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|3268.13||||3268.13|2764.83|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3268.13||||3268.13|2130.82|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3268.13||||3268.13|2224.29|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|CORESOURCE [1315]|CORESOURCE [131501]|3268.13||||3268.13|2130.82|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3268.13||||3268.13|2224.29|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3268.13||||3268.13|2614.5|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3268.13||||3268.13|1470.66|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|FIRST HEALTH [1375]|BENVEO/UCS [137512]|3268.13||||3268.13|2130.82|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3268.13||||3268.13|2130.82|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3268.13||||3268.13|2224.29|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3268.13||||3268.13|1470.66|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|AETNA [1015]|AETNA ACO WILCO [101532]|3268.13||||3268.13|2130.82|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3268.13||||3268.13|2130.82|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|||3268.13||||3268.13|980.44|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|3268.13||||3268.13|2764.83|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|CIGNA [1260]|CIGNA [126008]|3268.13||||3268.13|2764.83|2764.83|980.44 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|GEHA [1415]|GEHA - ASA [141503]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|CHAMPVA [1240]|CHAMP VA [124000]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|BCBS [1155]|TULSA BLUE [115531]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3268.13||||3268.13||| 102591|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW CANN PED RESET 7.0X40MM|UMR [2035]|UMR CORE [203505]|3268.13||||3268.13||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|1059.92||||1059.92|896.69|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|1059.92||||1059.92|896.69|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1059.92||||1059.92|896.69|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1059.92||||1059.92|896.69|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|||1059.92||||1059.92|317.98|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|||1059.92||||1059.92|317.98|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1059.92||||1059.92|721.38|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1059.92||||1059.92|721.38|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1059.92||||1059.92|476.96|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1059.92||||1059.92|476.96|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1059.92||||1059.92|476.96|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1059.92||||1059.92|476.96|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1059.92||||1059.92|721.38|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1059.92||||1059.92|721.38|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1059.92||||1059.92|721.38|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1059.92||||1059.92|721.38|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1059.92||||1059.92|582.96|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1059.92||||1059.92|582.96|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1059.92||||1059.92|896.69|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1059.92||||1059.92|896.69|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1059.92||||1059.92|691.07|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1059.92||||1059.92|847.94|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1059.92||||1059.92|847.94|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1059.92||||1059.92|324.23|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1059.92||||1059.92|324.23|896.69|317.98 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|BCBS [1155]|TULSA BLUE [115531]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|BCBS [1155]|TULSA BLUE [115531]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|GEHA [1415]|GEHA - ASA [141503]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|GEHA [1415]|GEHA - ASA [141503]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1059.92||||1059.92||| 10265|ERX|0250 - PHARMACY-GENERAL|INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1059.92||||1059.92||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4.44||||4.44|1.36|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4.44||||4.44|3.55|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4.44||||4.44|2.89|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4.44||||4.44|2.89|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|4.44||||4.44|2.44|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4.44||||4.44|3.75|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4.44||||4.44|2.89|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|4.44||||4.44|3.02|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|CORESOURCE [1315]|CORESOURCE [131501]|4.44||||4.44|2.89|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|4.44||||4.44|3.02|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|4.44||||4.44|2|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|4.44||||4.44|2.89|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|4.44||||4.44|2.89|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|4.44||||4.44|3.02|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|4.44||||4.44|2|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4.44||||4.44|2.89|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|AETNA [1015]|AETNA ACO WILCO [101532]|4.44||||4.44|2.89|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|||4.44||||4.44|1.33|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|4.44||||4.44|3.75|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|CIGNA [1260]|CIGNA [126008]|4.44||||4.44|3.75|3.75|1.33 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|CHAMPVA [1240]|CHAMP VA [124000]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|BCBS [1155]|TULSA BLUE [115531]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|GEHA [1415]|GEHA - ASA [141503]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|4.44||||4.44||| 10280|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PADDING CAST DELTA-ROL FIBER L4 YD X W4 IN STRETCH NONABSORBENT LATEX FREE|UMR [2035]|UMR CORE [203505]|4.44||||4.44||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|CIGNA [1260]|CIGNA [126008]|3253.60||||3253.60|2752.55|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|3253.60||||3253.60|2752.55|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|||3253.60||||3253.60|976.08|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|3253.60||||3253.60|2121.35|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3253.60||||3253.60|2121.35|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3253.60||||3253.60|1464.12|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3253.60||||3253.60|2121.35|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3253.60||||3253.60|1464.12|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3253.60||||3253.60|2214.4|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|3253.60||||3253.60|2121.35|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|3253.60||||3253.60|2121.35|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3253.60||||3253.60|2214.4|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3253.60||||3253.60|2214.4|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3253.60||||3253.60|2121.35|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|3253.60||||3253.60|2752.55|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3253.60||||3253.60|1789.48|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3253.60||||3253.60|2121.35|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3253.60||||3253.60|2121.35|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3253.60||||3253.60|2602.88|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3253.60||||3253.60|995.28|2752.55|976.08 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|UMR [2035]|UMR CORE [203505]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3253.60||||3253.60||| 102830|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE L74 MM FIBULA LEFT LATERAL 4 HOLE NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3253.60||||3253.60||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|913.00||||913.00|730.4|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|913.00||||913.00|595.28|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|913.00||||913.00|595.28|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|913.00||||913.00|502.15|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|913.00||||913.00|772.4|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|913.00||||913.00|595.28|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|913.00||||913.00|621.39|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|CORESOURCE [1315]|CORESOURCE [131501]|913.00||||913.00|595.28|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|913.00||||913.00|621.39|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|913.00||||913.00|410.85|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|FIRST HEALTH [1375]|BENVEO/UCS [137512]|913.00||||913.00|595.28|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|913.00||||913.00|279.29|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|913.00||||913.00|595.28|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|913.00||||913.00|621.39|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|913.00||||913.00|410.85|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|913.00||||913.00|595.28|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|AETNA [1015]|AETNA ACO WILCO [101532]|913.00||||913.00|595.28|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|||913.00||||913.00|273.9|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|913.00||||913.00|772.4|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|CIGNA [1260]|CIGNA [126008]|913.00||||913.00|772.4|772.4|273.9 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|GEHA [1415]|GEHA - ASA [141503]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|CHAMPVA [1240]|CHAMP VA [124000]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|BCBS [1155]|TULSA BLUE [115531]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|UMR [2035]|UMR CORE [203505]|913.00||||913.00||| 102831|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT ENDOSCOPIC INSTRUMENT PUSHLOCK METAL NITINOL 1.1 MM OD17 GA ODSEC2.9 MM CANNULA DRILL NEEDLE PORTAL DILATOR DISPOSABLE ARTHROSCOPY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|913.00||||913.00||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|86.52||||86.52|73.2|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|||86.52||||86.52|25.96|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|86.52||||86.52|56.41|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|86.52||||86.52|38.93|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|86.52||||86.52|56.41|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|86.52||||86.52|56.41|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|86.52||||86.52|61.8|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|86.52||||86.52|58.89|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|86.52||||86.52|38.93|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CORESOURCE [1315]|CORESOURCE [131501]|86.52||||86.52|56.41|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|86.52||||86.52|56.41|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|86.52||||86.52|58.89|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|86.52||||86.52|47.59|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|86.52||||86.52|58.89|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|86.52||||86.52|73.2|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|86.52||||86.52|56.41|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|86.52||||86.52|61.8|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CIGNA [1260]|CIGNA [126008]|86.52||||86.52|73.2|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.52||||86.52|56.41|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.52||||86.52|56.41|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|86.52||||86.52|69.22|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.52||||86.52|26.47|73.2|25.96 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UMR [2035]|UMR CORE [203505]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|TULSA BLUE [115531]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|GEHA [1415]|GEHA - ASA [141503]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|86.52||||86.52||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.52||||86.52|26.47|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|86.52||||86.52|69.22|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.52||||86.52|56.41|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.52||||86.52|56.41|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|86.52||||86.52|73.2|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|86.52||||86.52|47.59|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|86.52||||86.52|56.41|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CORESOURCE [1315]|CORESOURCE [131501]|86.52||||86.52|56.41|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|86.52||||86.52|58.89|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|86.52||||86.52|58.89|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|86.52||||86.52|61.8|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|86.52||||86.52|61.8|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|86.52||||86.52|38.93|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|FIRST HEALTH [1375]|BENVEO/UCS [137512]|86.52||||86.52|56.41|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|86.52||||86.52|56.41|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|86.52||||86.52|38.93|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|86.52||||86.52|58.89|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AETNA [1015]|AETNA ACO WILCO [101532]|86.52||||86.52|56.41|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|86.52||||86.52|56.41|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|||86.52||||86.52|25.96|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|86.52||||86.52|73.2|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CIGNA [1260]|CIGNA [126008]|86.52||||86.52|73.2|73.2|25.96 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CHAMPVA [1240]|CHAMP VA [124000]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|TULSA BLUE [115531]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|GEHA [1415]|GEHA - ASA [141503]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|86.52||||86.52||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UMR [2035]|UMR CORE [203505]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|86.52||||86.52|73.2|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|86.52||||86.52|73.2|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|||86.52||||86.52|25.96|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|86.52||||86.52|56.41|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|86.52||||86.52|56.41|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|86.52||||86.52|58.89|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|86.52||||86.52|38.93|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|86.52||||86.52|56.41|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|86.52||||86.52|56.41|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|86.52||||86.52|38.93|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|86.52||||86.52|61.8|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|86.52||||86.52|58.89|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|86.52||||86.52|56.41|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|86.52||||86.52|56.41|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|86.52||||86.52|58.89|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|86.52||||86.52|47.59|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|86.52||||86.52|73.2|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|86.52||||86.52|61.8|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.52||||86.52|56.41|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.52||||86.52|56.41|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|86.52||||86.52|69.22|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.52||||86.52|26.47|73.2|25.96 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|TULSA BLUE [115531]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA - ASA [141503]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|86.52||||86.52||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|86.52||||86.52||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.56||||46.56|14.24|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|46.56||||46.56|37.25|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.56||||46.56|30.36|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.56||||46.56|30.36|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|46.56||||46.56|25.61|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|46.56||||46.56|30.36|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|46.56||||46.56|31.69|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|CORESOURCE [1315]|CORESOURCE [131501]|46.56||||46.56|30.36|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|46.56||||46.56|39.39|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|46.56||||46.56|31.69|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|46.56||||46.56|20.95|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|FIRST HEALTH [1375]|BENVEO/UCS [137512]|46.56||||46.56|30.36|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|46.56||||46.56|30.36|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|46.56||||46.56|31.69|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|46.56||||46.56|20.95|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|46.56||||46.56|30.36|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|AETNA [1015]|AETNA ACO WILCO [101532]|46.56||||46.56|30.36|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|||46.56||||46.56|13.97|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|46.56||||46.56|39.39|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|CIGNA [1260]|CIGNA [126008]|46.56||||46.56|39.39|39.39|13.97 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|GEHA [1415]|GEHA - ASA [141503]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|BCBS [1155]|TULSA BLUE [115531]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|CHAMPVA [1240]|CHAMP VA [124000]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|46.56||||46.56||| 102890|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 3|UMR [2035]|UMR CORE [203505]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|46.56||||46.56|39.39|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|||46.56||||46.56|13.97|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|46.56||||46.56|30.36|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|46.56||||46.56|20.95|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|46.56||||46.56|31.69|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|46.56||||46.56|30.36|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|FIRST HEALTH [1375]|BENVEO/UCS [137512]|46.56||||46.56|30.36|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|46.56||||46.56|31.69|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|CORESOURCE [1315]|CORESOURCE [131501]|46.56||||46.56|30.36|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|46.56||||46.56|20.95|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|46.56||||46.56|31.69|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|46.56||||46.56|30.36|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|46.56||||46.56|39.39|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|46.56||||46.56|25.61|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|AETNA [1015]|AETNA ACO WILCO [101532]|46.56||||46.56|30.36|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.56||||46.56|30.36|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.56||||46.56|30.36|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|CIGNA [1260]|CIGNA [126008]|46.56||||46.56|39.39|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|46.56||||46.56|37.25|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.56||||46.56|14.24|39.39|13.97 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|UMR [2035]|UMR CORE [203505]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|BCBS [1155]|TULSA BLUE [115531]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|CHAMPVA [1240]|CHAMP VA [124000]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|GEHA [1415]|GEHA - ASA [141503]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46.56||||46.56||| 102891|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 4|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.56||||46.56|14.24|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.56||||46.56|30.36|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|46.56||||46.56|37.25|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.56||||46.56|30.36|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|46.56||||46.56|39.39|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|46.56||||46.56|30.36|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|CORESOURCE [1315]|CORESOURCE [131501]|46.56||||46.56|30.36|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|46.56||||46.56|31.69|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|46.56||||46.56|25.61|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|46.56||||46.56|31.69|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|46.56||||46.56|20.95|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|FIRST HEALTH [1375]|BENVEO/UCS [137512]|46.56||||46.56|30.36|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|46.56||||46.56|30.36|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|46.56||||46.56|31.69|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|46.56||||46.56|20.95|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|46.56||||46.56|30.36|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|AETNA [1015]|AETNA ACO WILCO [101532]|46.56||||46.56|30.36|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|||46.56||||46.56|13.97|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|46.56||||46.56|39.39|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|CIGNA [1260]|CIGNA [126008]|46.56||||46.56|39.39|39.39|13.97 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|CHAMPVA [1240]|CHAMP VA [124000]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|BCBS [1155]|TULSA BLUE [115531]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|GEHA [1415]|GEHA - ASA [141503]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|UMR [2035]|UMR CORE [203505]|46.56||||46.56||| 102892|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|AIRWAY LMA UNIQUE CRVD SZ 5|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.56||||46.56||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|CIGNA [1260]|CIGNA [126008]|393.38||||393.38|332.8|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|393.38||||393.38|332.8|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|||393.38||||393.38|118.02|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|AETNA [1015]|AETNA ACO WILCO [101532]|393.38||||393.38|256.48|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|393.38||||393.38|256.48|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|393.38||||393.38|177.02|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|393.38||||393.38|267.73|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|393.38||||393.38|256.48|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|FIRST HEALTH [1375]|BENVEO/UCS [137512]|393.38||||393.38|256.48|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|393.38||||393.38|177.02|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|393.38||||393.38|267.73|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|CORESOURCE [1315]|CORESOURCE [131501]|393.38||||393.38|256.48|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|393.38||||393.38|267.73|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|393.38||||393.38|256.48|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|393.38||||393.38|332.8|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|393.38||||393.38|216.36|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|393.38||||393.38|256.48|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|393.38||||393.38|256.48|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|393.38||||393.38|314.7|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|393.38||||393.38|120.33|332.8|118.02 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|BCBS [1155]|TULSA BLUE [115531]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|UMR [2035]|UMR CORE [203505]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|CHAMPVA [1240]|CHAMP VA [124000]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|GEHA [1415]|GEHA - ASA [141503]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|393.38||||393.38||| 10298|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|RELOAD STAPLER ENDOPATH ETS TITANIUM L45 MM X H3.5 MM H1.5 MM REGULAR TISSUE 6 ROW LINEAR CUT ARTICULATE STERILE LATEX FREE DISPOSABLE BROWN|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|393.38||||393.38||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.86||||12.86|3.93|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|12.86||||12.86|10.29|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|12.86||||12.86|10.88|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|12.86||||12.86|7.07|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|12.86||||12.86|7.07|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|12.86||||12.86|8.75|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|12.86||||12.86|8.75|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|CORESOURCE [1315]|CORESOURCE [131501]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|CORESOURCE [1315]|CORESOURCE [131501]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|12.86||||12.86|10.88|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|12.86||||12.86|8.75|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|12.86||||12.86|8.75|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|12.86||||12.86|5.79|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|12.86||||12.86|5.79|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|FIRST HEALTH [1375]|BENVEO/UCS [137512]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|FIRST HEALTH [1375]|BENVEO/UCS [137512]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|12.86||||12.86|5.79|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|12.86||||12.86|5.79|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|12.86||||12.86|8.75|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|12.86||||12.86|8.75|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|12.86||||12.86|10.29|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.86||||12.86|3.93|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|AETNA [1015]|AETNA ACO WILCO [101532]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|AETNA [1015]|AETNA ACO WILCO [101532]|12.86||||12.86|8.38|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|||12.86||||12.86|3.86|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|||12.86||||12.86|3.86|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|12.86||||12.86|10.88|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|12.86||||12.86|10.88|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|CIGNA [1260]|CIGNA [126008]|12.86||||12.86|10.88|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|CIGNA [1260]|CIGNA [126008]|12.86||||12.86|10.88|10.88|3.86 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|GEHA [1415]|GEHA - ASA [141503]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|GEHA [1415]|GEHA - ASA [141503]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|CHAMPVA [1240]|CHAMP VA [124000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|CHAMPVA [1240]|CHAMP VA [124000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS [1155]|TULSA BLUE [115531]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS [1155]|TULSA BLUE [115531]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UMR [2035]|UMR CORE [203505]|12.86||||12.86||| 103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UMR [2035]|UMR CORE [203505]|12.86||||12.86||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|CIGNA [1260]|CIGNA [126008]|2350.40||||2350.40|1988.44|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2350.40||||2350.40|1988.44|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|AETNA [1015]|AETNA ACO WILCO [101532]|2350.40||||2350.40|1532.46|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|2350.40||||2350.40|1532.46|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|2350.40||||2350.40|1599.68|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|2350.40||||2350.40|1057.68|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|2350.40||||2350.40|1532.46|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|2350.40||||2350.40|1532.46|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|2350.40||||2350.40|1057.68|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2350.40||||2350.40|1599.68|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|CORESOURCE [1315]|CORESOURCE [131501]|2350.40||||2350.40|1532.46|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2350.40||||2350.40|1532.46|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|2350.40||||2350.40|1599.68|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|2350.40||||2350.40|1292.72|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2350.40||||2350.40|1988.44|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|||2350.40||||2350.40|705.12|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2350.40||||2350.40|1532.46|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2350.40||||2350.40|1532.46|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2350.40||||2350.40|1880.32|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2350.40||||2350.40|718.99|1988.44|705.12 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|UMR [2035]|UMR CORE [203505]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|BCBS [1155]|TULSA BLUE [115531]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|CHAMPVA [1240]|CHAMP VA [124000]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|GEHA [1415]|GEHA - ASA [141503]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2350.40||||2350.40||| 103068|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ACUTRAK 2 TITANIUM FULL THREAD L50 MM OD4.7 MM COMPRESSION CANNULATED HEADLESS HEXAGONAL NONSTERILE ACCEPTS .062 IN GUIDEWIRE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|2350.40||||2350.40||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1456.65||||1456.65|445.59|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1456.65||||1456.65|1165.32|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1456.65||||1456.65|949.74|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1456.65||||1456.65|949.74|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1456.65||||1456.65|1232.33|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1456.65||||1456.65|801.16|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1456.65||||1456.65|949.74|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|CORESOURCE [1315]|CORESOURCE [131501]|1456.65||||1456.65|949.74|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1456.65||||1456.65|991.4|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1456.65||||1456.65|991.4|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1456.65||||1456.65|655.49|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1456.65||||1456.65|949.74|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1456.65||||1456.65|949.74|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1456.65||||1456.65|655.49|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1456.65||||1456.65|991.4|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1456.65||||1456.65|949.74|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|AETNA [1015]|AETNA ACO WILCO [101532]|1456.65||||1456.65|949.74|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1456.65||||1456.65|1232.33|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|||1456.65||||1456.65|436.99|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|CIGNA [1260]|CIGNA [126008]|1456.65||||1456.65|1232.33|1232.33|436.99 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|CHAMPVA [1240]|CHAMP VA [124000]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|BCBS [1155]|TULSA BLUE [115531]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|GEHA [1415]|GEHA - ASA [141503]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|UMR [2035]|UMR CORE [203505]|1456.65||||1456.65||| 103069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 4.7MM ACUTRAK 2 LONG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1456.65||||1456.65||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1141.25||||1141.25|744.1|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1141.25||||1141.25|744.1|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1141.25||||1141.25|913|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1141.25||||1141.25|349.11|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1141.25||||1141.25|776.73|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1141.25||||1141.25|627.69|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1141.25||||1141.25|513.56|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|CORESOURCE [1315]|CORESOURCE [131501]|1141.25||||1141.25|744.1|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1141.25||||1141.25|744.1|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1141.25||||1141.25|965.5|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1141.25||||1141.25|744.1|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|CIGNA [1260]|CIGNA [126008]|1141.25||||1141.25|965.5|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|AETNA [1015]|AETNA ACO WILCO [101532]|1141.25||||1141.25|744.1|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|||1141.25||||1141.25|342.37|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1141.25||||1141.25|965.5|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1141.25||||1141.25|776.73|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1141.25||||1141.25|513.56|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1141.25||||1141.25|776.73|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1141.25||||1141.25|744.1|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1141.25||||1141.25|744.1|965.5|342.37 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|CHAMPVA [1240]|CHAMP VA [124000]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|GEHA [1415]|GEHA - ASA [141503]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|BCBS [1155]|TULSA BLUE [115531]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|UMR [2035]|UMR CORE [203505]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1141.25||||1141.25||| 103074|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL 2.4MM CANNULATED ACROMIOCLAVICULAR REPAIR|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1141.25||||1141.25||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3506.75||||3506.75|2286.4|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3506.75||||3506.75|2386.69|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3506.75||||3506.75|2386.69|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3506.75||||3506.75|1578.04|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|FIRST HEALTH [1375]|BENVEO/UCS [137512]|3506.75||||3506.75|2286.4|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3506.75||||3506.75|2286.4|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3506.75||||3506.75|1578.04|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3506.75||||3506.75|2805.4|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|3506.75||||3506.75|2966.71|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3506.75||||3506.75|2286.4|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|CORESOURCE [1315]|CORESOURCE [131501]|3506.75||||3506.75|2286.4|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3506.75||||3506.75|2286.4|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3506.75||||3506.75|2386.69|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3506.75||||3506.75|1928.71|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|||3506.75||||3506.75|1052.02|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|CIGNA [1260]|CIGNA [126008]|3506.75||||3506.75|2966.71|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|3506.75||||3506.75|2966.71|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|AETNA [1015]|AETNA ACO WILCO [101532]|3506.75||||3506.75|2286.4|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3506.75||||3506.75|2286.4|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3506.75||||3506.75|1072.71|2966.71|1052.02 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|CHAMPVA [1240]|CHAMP VA [124000]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|UMR [2035]|UMR CORE [203505]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|BCBS [1155]|TULSA BLUE [115531]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|GEHA [1415]|GEHA - ASA [141503]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3506.75||||3506.75||| 103090|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE TITANIUM FIBULA RIGHT DISTAL 8 HOLE LOCK|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3506.75||||3506.75||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|||1037.50||||1037.50|311.25|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1037.50||||1037.50|570.63|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1037.50||||1037.50|676.45|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1037.50||||1037.50|706.12|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|CORESOURCE [1315]|CORESOURCE [131501]|1037.50||||1037.50|676.45|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1037.50||||1037.50|676.45|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1037.50||||1037.50|877.73|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1037.50||||1037.50|706.12|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1037.50||||1037.50|466.88|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1037.50||||1037.50|676.45|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1037.50||||1037.50|676.45|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|CIGNA [1260]|CIGNA [126008]|1037.50||||1037.50|877.73|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1037.50||||1037.50|877.73|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|AETNA [1015]|AETNA ACO WILCO [101532]|1037.50||||1037.50|676.45|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1037.50||||1037.50|676.45|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1037.50||||1037.50|706.12|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1037.50||||1037.50|676.45|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1037.50||||1037.50|466.88|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1037.50||||1037.50|830|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1037.50||||1037.50|317.37|877.73|311.25 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|BCBS [1155]|TULSA BLUE [115531]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|UMR [2035]|UMR CORE [203505]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|GEHA [1415]|GEHA - ASA [141503]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|CHAMPVA [1240]|CHAMP VA [124000]|1037.50||||1037.50||| 103094|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDE DRILL 1.35-2.6 MM 4 MM LPS PARTIAL THREAD SCREW|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1037.50||||1037.50||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|289.17||||289.17|7|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|289.17||||289.17|130.13|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|558.17||||558.17|379.89|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|289.17||||289.17|196.81|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|558.17||||558.17|379.89|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|289.17||||289.17|7|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|289.17||||289.17|130.13|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|289.17||||289.17|196.81|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|558.17||||558.17|251.18|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|289.17||||289.17|130.13|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|289.17||||289.17|196.81|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|289.17||||289.17|88.46|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|558.17||||558.17|251.18|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|289.17||||289.17|130.13|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|289.17||||289.17|130.13|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|558.17||||558.17|379.89|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|289.17||||289.17|130.13|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|558.17||||558.17|170.74|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|558.17||||558.17|446.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|558.17||||558.17|446.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|289.17||||289.17|7|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|558.17||||558.17|17.5|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|289.17||||289.17|231.34|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|289.17||||289.17|231.34|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|558.17||||558.17|14|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|289.17||||289.17|88.46|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|558.17||||558.17|170.74|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|558.17||||558.17|379.89|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|289.17||||289.17|244.64|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|558.17||||558.17|17.5|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|289.17||||289.17|196.81|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|289.17||||289.17|7|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|289.17||||289.17|196.81|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|289.17||||289.17|159.04|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|289.17||||289.17|244.64|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|TULSA BLUE [115531]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|TULSA BLUE [115531]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA - ASA [141503]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA - ASA [141503]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA - ASA [141503]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|TULSA BLUE [115531]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|TULSA BLUE [115531]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA - ASA [141503]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|289.17||||289.17|196.81|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|||558.17||||558.17|167.45|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|558.17||||558.17|472.21|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|289.17||||289.17|196.81|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|558.17||||558.17|379.89|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|||289.17||||289.17|86.75|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|||558.17||||558.17|167.45|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|558.17||||558.17|472.21|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|558.17||||558.17|472.21|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|558.17||||558.17|379.89|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|289.17||||289.17|159.04|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|289.17||||289.17|244.64|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|289.17||||289.17|244.64|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|558.17||||558.17|472.21|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|||289.17||||289.17|86.75|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|558.17||||558.17|306.99|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|289.17||||289.17|159.04|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|558.17||||558.17|472.21|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|289.17||||289.17|196.81|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|289.17||||289.17|244.64|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|289.17||||289.17|7|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|558.17||||558.17|472.21|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|289.17||||289.17|7|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|289.17||||289.17|196.81|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|289.17||||289.17|244.64|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|289.17||||289.17|231.34|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|289.17||||289.17|88.46|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|558.17||||558.17|306.99|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|289.17||||289.17|244.64|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|558.17||||558.17|251.18|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|289.17||||289.17|188.54|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|558.17||||558.17|251.18|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|289.17||||289.17|244.64|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|289.17||||289.17|244.64|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|558.17||||558.17|14|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|||289.17||||289.17|86.75|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA - ASA [141503]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|TULSA BLUE [115531]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|558.17||||558.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|558.17||||558.17|363.93|472.21|7 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|289.17||||289.17||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|289.17||||289.17||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|816.61||||816.61|532.43|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|816.61||||816.61|367.47|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|CIGNA [1260]|CIGNA [126008]|816.61||||816.61|690.85|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|816.61||||816.61|555.78|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|816.61||||816.61|690.85|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|816.61||||816.61|532.43|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|816.61||||816.61|367.47|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|816.61||||816.61|555.78|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|816.61||||816.61|555.78|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|816.61||||816.61|449.13|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|816.61||||816.61|690.85|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|816.61||||816.61|532.43|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|816.61||||816.61|532.43|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|816.61||||816.61|532.43|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|816.61||||816.61|532.43|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|||816.61||||816.61|244.98|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|816.61||||816.61|532.43|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|816.61||||816.61|653.29|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|816.61||||816.61|249.8|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|816.61||||816.61|532.43|690.85|244.98 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|UMR [2035]|UMR CORE [203505]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|816.61||||816.61||| 103391|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5MM 28MM AXSOS 3 TITANIUM LOCK SELF TAP NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|816.61||||816.61||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|CORESOURCE [1315]|CORESOURCE [131501]|205.00||||205.00|133.66|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|205.00||||205.00|164|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|205.00||||205.00|139.52|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|205.00||||205.00|133.66|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|205.00||||205.00|133.66|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|205.00||||205.00|112.75|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|205.00||||205.00|133.66|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|205.00||||205.00|92.25|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|205.00||||205.00|173.43|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|205.00||||205.00|133.66|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|205.00||||205.00|133.66|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|205.00||||205.00|92.25|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|205.00||||205.00|62.71|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|205.00||||205.00|139.52|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|205.00||||205.00|173.43|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|AETNA [1015]|AETNA ACO WILCO [101532]|205.00||||205.00|133.66|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|205.00||||205.00|139.52|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|205.00||||205.00|133.66|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|CIGNA [1260]|CIGNA [126008]|205.00||||205.00|173.43|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|||205.00||||205.00|61.5|173.43|61.5 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|CHAMPVA [1240]|CHAMP VA [124000]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|GEHA [1415]|GEHA - ASA [141503]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|BCBS [1155]|TULSA BLUE [115531]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|UMR [2035]|UMR CORE [203505]|205.00||||205.00||| 103448|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 18MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|205.00||||205.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|200.00||||200.00|130.4|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|200.00||||200.00|130.4|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|200.00||||200.00|160|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|200.00||||200.00|61.18|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|200.00||||200.00|136.12|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|200.00||||200.00|169.2|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|||200.00||||200.00|60|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|AETNA [1015]|AETNA ACO WILCO [101532]|200.00||||200.00|130.4|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|200.00||||200.00|169.2|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|200.00||||200.00|130.4|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|CIGNA [1260]|CIGNA [126008]|200.00||||200.00|169.2|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|200.00||||200.00|130.4|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|200.00||||200.00|90|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|CORESOURCE [1315]|CORESOURCE [131501]|200.00||||200.00|130.4|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|200.00||||200.00|130.4|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|200.00||||200.00|130.4|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|200.00||||200.00|136.12|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|200.00||||200.00|110|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|200.00||||200.00|90|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|200.00||||200.00|136.12|169.2|60 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|CHAMPVA [1240]|CHAMP VA [124000]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|GEHA [1415]|GEHA - ASA [141503]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|BCBS [1155]|TULSA BLUE [115531]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|UMR [2035]|UMR CORE [203505]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|200.00||||200.00||| 103449|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 3.5MM 20MM TITANIUM T15 STANDARD CORTICAL SELF TAP NONSTERILE CLAVICLE PLATE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|200.00||||200.00||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|67.60||||67.60|54.08|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67.60||||67.60|20.68|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|67.60||||67.60|37.18|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|67.60||||67.60|57.19|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67.60||||67.60|44.08|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|67.60||||67.60|46.01|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|67.60||||67.60|44.08|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67.60||||67.60|44.08|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|67.60||||67.60|30.42|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|67.60||||67.60|46.01|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|67.60||||67.60|44.08|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|67.60||||67.60|46.01|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|||67.60||||67.60|20.28|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|CIGNA [1260]|CIGNA [126008]|67.60||||67.60|57.19|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|67.60||||67.60|57.19|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|67.60||||67.60|44.08|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|67.60||||67.60|44.08|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|67.60||||67.60|30.42|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|67.60||||67.60|44.08|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|67.60||||67.60|44.08|57.19|20.28 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|UMR [2035]|UMR CORE [203505]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|67.60||||67.60||| 103527|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC ACUMED L150 MM OD1.3 MM NONTHREAD NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|67.60||||67.60||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|||1137.10||||1137.10|341.13|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1137.10||||1137.10|773.91|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|1137.10||||1137.10|741.39|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1137.10||||1137.10|741.39|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1137.10||||1137.10|741.39|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|CIGNA [1260]|CIGNA [126008]|1137.10||||1137.10|961.99|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1137.10||||1137.10|741.39|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1137.10||||1137.10|511.7|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1137.10||||1137.10|773.91|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|1137.10||||1137.10|741.39|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1137.10||||1137.10|961.99|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1137.10||||1137.10|741.39|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1137.10||||1137.10|511.7|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1137.10||||1137.10|909.68|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1137.10||||1137.10|347.84|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1137.10||||1137.10|625.41|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1137.10||||1137.10|741.39|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1137.10||||1137.10|773.91|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1137.10||||1137.10|741.39|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1137.10||||1137.10|961.99|961.99|341.13 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|UMR [2035]|UMR CORE [203505]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|1137.10||||1137.10||| 103528|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL OD2.7 MM QUICK CONNECT CANNULATED NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1137.10||||1137.10||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|572.70||||572.70|458.16|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|572.70||||572.70|175.19|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|572.70||||572.70|314.99|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|CORESOURCE [1315]|CORESOURCE [131501]|572.70||||572.70|373.4|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|572.70||||572.70|373.4|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|572.70||||572.70|373.4|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|572.70||||572.70|484.5|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|572.70||||572.70|373.4|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|572.70||||572.70|389.78|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|572.70||||572.70|257.72|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|FIRST HEALTH [1375]|BENVEO/UCS [137512]|572.70||||572.70|373.4|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|572.70||||572.70|373.4|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|572.70||||572.70|257.72|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|572.70||||572.70|389.78|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|572.70||||572.70|389.78|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|572.70||||572.70|373.4|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|AETNA [1015]|AETNA ACO WILCO [101532]|572.70||||572.70|373.4|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|572.70||||572.70|484.5|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|||572.70||||572.70|171.81|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|CIGNA [1260]|CIGNA [126008]|572.70||||572.70|484.5|484.5|171.81 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|CHAMPVA [1240]|CHAMP VA [124000]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|BCBS [1155]|TULSA BLUE [115531]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|GEHA [1415]|GEHA - ASA [141503]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|UMR [2035]|UMR CORE [203505]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|572.70||||572.70||| 103529|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL QUICK RELEASE LAG SURGIBIT 3.5MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|572.70||||572.70||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|722.80||||722.80|611.49|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|||722.80||||722.80|216.84|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|722.80||||722.80|471.27|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|722.80||||722.80|471.27|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|722.80||||722.80|491.94|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|722.80||||722.80|471.27|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|CIGNA [1260]|CIGNA [126008]|722.80||||722.80|611.49|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|722.80||||722.80|325.26|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|722.80||||722.80|491.94|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|722.80||||722.80|471.27|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|722.80||||722.80|611.49|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|722.80||||722.80|491.94|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|722.80||||722.80|325.26|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|722.80||||722.80|471.27|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|722.80||||722.80|471.27|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|722.80||||722.80|471.27|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|722.80||||722.80|397.54|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|722.80||||722.80|471.27|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|722.80||||722.80|221.1|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|722.80||||722.80|578.24|611.49|216.84 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|UMR [2035]|UMR CORE [203505]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|722.80||||722.80||| 103532|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 48MM TITANIUM LONG THREAD CANCELLOUS CANNULATED NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|722.80||||722.80||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|12.86||||12.86|10.29|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|12.86||||12.86|8.75|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|12.86||||12.86|8.38|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|12.86||||12.86|8.38|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|12.86||||12.86|8.75|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|12.86||||12.86|8.38|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|12.86||||12.86|5.79|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|12.86||||12.86|8.38|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|12.86||||12.86|5.79|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|12.86||||12.86|8.75|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12.86||||12.86|8.38|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|12.86||||12.86|10.88|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|12.86||||12.86|10.88|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|||12.86||||12.86|3.86|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.86||||12.86|8.38|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.86||||12.86|3.93|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|12.86||||12.86|10.88|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|12.86||||12.86|7.07|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.86||||12.86|8.38|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|12.86||||12.86|8.38|10.88|3.86 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|12.86||||12.86||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|12.86||||12.86||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|CIGNA [1260]|CIGNA [126008]|453.44||||453.44|383.61|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|453.44||||453.44|383.61|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|453.44||||453.44|295.64|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|453.44||||453.44|249.39|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|453.44||||453.44|295.64|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|453.44||||453.44|308.61|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|453.44||||453.44|295.64|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|453.44||||453.44|204.05|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|453.44||||453.44|204.05|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|453.44||||453.44|295.64|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|453.44||||453.44|295.64|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|453.44||||453.44|295.64|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|453.44||||453.44|295.64|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|453.44||||453.44|383.61|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|||453.44||||453.44|136.03|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|453.44||||453.44|362.75|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|453.44||||453.44|295.64|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|453.44||||453.44|138.71|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|453.44||||453.44|308.61|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|453.44||||453.44|308.61|383.61|136.03 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|UMR [2035]|UMR CORE [203505]|453.44||||453.44||| 103585|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PEG FIXATION 2MM 24MM FOSSA RADIUS DISTAL VOLAR SMOOTH LOCK SCREW CADDY TITANIUM GEMINUS NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|453.44||||453.44||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|88.40||||88.40|60.17|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|88.40||||88.40|57.64|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|88.40||||88.40|70.72|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|88.40||||88.40|27.04|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|88.40||||88.40|60.17|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|88.40||||88.40|39.78|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|88.40||||88.40|48.62|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|88.40||||88.40|74.79|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|CORESOURCE [1315]|CORESOURCE [131501]|88.40||||88.40|57.64|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|88.40||||88.40|39.78|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|88.40||||88.40|57.64|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|FIRST HEALTH [1375]|BENVEO/UCS [137512]|88.40||||88.40|57.64|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|88.40||||88.40|57.64|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|88.40||||88.40|60.17|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|AETNA [1015]|AETNA ACO WILCO [101532]|88.40||||88.40|57.64|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|88.40||||88.40|57.64|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|||88.40||||88.40|26.52|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|88.40||||88.40|74.79|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|88.40||||88.40|57.64|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|CIGNA [1260]|CIGNA [126008]|88.40||||88.40|74.79|74.79|26.52 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|CHAMPVA [1240]|CHAMP VA [124000]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|GEHA [1415]|GEHA - ASA [141503]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|BCBS [1155]|TULSA BLUE [115531]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|88.40||||88.40||| 103587|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TROCAR OPTVW 5X100 REPROCESS|UMR [2035]|UMR CORE [203505]|88.40||||88.40||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|25.33||||25.33|21.43|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|25.33||||25.33|21.43|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|||25.33||||25.33|7.6|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|25.33||||25.33|17.24|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|25.33||||25.33|17.24|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|||25.33||||25.33|7.6|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|25.33||||25.33|11.4|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|CIGNA [1260]|CIGNA [126008]|25.33||||25.33|21.43|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|25.33||||25.33|11.4|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|25.33||||25.33|17.24|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|25.33||||25.33|11.4|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|25.33||||25.33|13.93|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|25.33||||25.33|17.24|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|25.33||||25.33|17.24|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|25.33||||25.33|13.93|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|25.33||||25.33|11.4|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|25.33||||25.33|21.43|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|25.33||||25.33|21.43|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|25.33||||25.33|17.24|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.33||||25.33|7.75|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|25.33||||25.33|20.26|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.33||||25.33|16.52|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|25.33||||25.33|20.26|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.33||||25.33|7.75|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|CIGNA [1260]|CIGNA [126008]|25.33||||25.33|21.43|21.43|7.6 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|UMR [2035]|UMR CORE [203505]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|UMR [2035]|UMR CORE [203505]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|25.33||||25.33||| 10371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 10 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|25.33||||25.33||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|||86.90||||86.90|26.07|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|||86.90||||86.90|26.07|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|||86.90||||86.90|26.07|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|86.90||||86.90|73.52|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|86.90||||86.90|73.52|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|86.90||||86.90|73.52|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|86.90||||86.90|73.52|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|86.90||||86.90|73.52|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|86.90||||86.90|73.52|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.90||||86.90|26.58|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.90||||86.90|26.58|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|86.90||||86.90|69.52|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|86.90||||86.90|69.52|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|86.90||||86.90|69.52|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|86.90||||86.90|73.52|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|86.90||||86.90|47.8|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|86.90||||86.90|47.8|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|86.90||||86.90|59.14|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|86.90||||86.90|59.14|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|86.90||||86.90|59.14|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|86.90||||86.90|73.52|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|86.90||||86.90|47.8|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|86.90||||86.90|73.52|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|86.90||||86.90|59.14|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|86.90||||86.90|59.14|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|86.90||||86.90|39.11|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|86.90||||86.90|39.11|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|86.90||||86.90|39.11|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA - ASA [141503]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA - ASA [141503]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA - ASA [141503]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|TULSA BLUE [115531]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|TULSA BLUE [115531]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|TULSA BLUE [115531]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|86.90||||86.90|39.11|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.90||||86.90|26.58|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|86.90||||86.90|39.11|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|86.90||||86.90|59.14|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|86.90||||86.90|39.11|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|86.90||||86.90|59.14|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|86.90||||86.90|59.14|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|86.90||||86.90|59.14|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|86.90||||86.90|56.66|73.52|26.07 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|86.90||||86.90||| 10372|ERX|0250 - PHARMACY-GENERAL|LABETALOL 5 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86.90||||86.90||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|CIGNA [1260]|CIGNA [126008]|14.75||||14.75|12.48|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|CIGNA [1260]|CIGNA [126008]|14.75||||14.75|12.48|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|14.75||||14.75|12.48|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|||14.75||||14.75|4.42|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|14.75||||14.75|12.48|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|14.75||||14.75|10.04|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|14.75||||14.75|10.04|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|14.75||||14.75|6.64|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|14.75||||14.75|6.64|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|14.75||||14.75|6.64|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|14.75||||14.75|10.04|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|14.75||||14.75|10.04|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|14.75||||14.75|10.04|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|14.75||||14.75|10.04|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|14.75||||14.75|8.11|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|14.75||||14.75|8.11|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|14.75||||14.75|12.48|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|14.75||||14.75|12.48|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|14.75||||14.75|6.64|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.75||||14.75|9.62|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|14.75||||14.75|11.8|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|14.75||||14.75|11.8|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|||14.75||||14.75|4.42|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.75||||14.75|4.51|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.75||||14.75|4.51|12.48|4.42 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|UMR [2035]|UMR CORE [203505]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|UMR [2035]|UMR CORE [203505]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|14.75||||14.75||| 10374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 200 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|14.75||||14.75||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.63||||17.63|5.39|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|17.63||||17.63|14.1|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.63||||17.63|11.49|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|17.63||||17.63|14.91|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|17.63||||17.63|9.7|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|17.63||||17.63|12|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|17.63||||17.63|11.49|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|17.63||||17.63|12|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|17.63||||17.63|7.93|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|17.63||||17.63|11.49|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|17.63||||17.63|11.49|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.63||||17.63|11.49|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|17.63||||17.63|7.93|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|CORESOURCE [1315]|CORESOURCE [131501]|17.63||||17.63|11.49|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|17.63||||17.63|12|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|17.63||||17.63|11.49|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|17.63||||17.63|11.49|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|CIGNA [1260]|CIGNA [126008]|17.63||||17.63|14.91|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|17.63||||17.63|14.91|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|||17.63||||17.63|5.29|14.91|5.29 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|17.63||||17.63||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.63||||17.63||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.63||||17.63||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|GEHA [1415]|GEHA - ASA [141503]|17.63||||17.63||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|17.63||||17.63||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17.63||||17.63||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|17.63||||17.63||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|17.63||||17.63||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.63||||17.63||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|17.63||||17.63||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|G